Provider Demographics
NPI:1982311916
Name:MILL CITY DENTAL PA
Entity Type:Organization
Organization Name:MILL CITY DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-377-3740
Mailing Address - Street 1:2218 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405
Mailing Address - Country:US
Mailing Address - Phone:612-377-3740
Mailing Address - Fax:612-377-5004
Practice Address - Street 1:2218 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405
Practice Address - Country:US
Practice Address - Phone:612-377-3740
Practice Address - Fax:612-377-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty